HSE DEPARTMENT ACTIVITIES REPORT

• Supervisor (white)

  Yes

  No

  N/A

• Foreman (black)

  Yes

  No

  N/A

• Workers (yellow)

  Yes

  No

  N/A

• Date & Time

  Date

• HSE Member

• Location

PRELIMINARY CHECK

• All workers weare appropriate PPE according to DTRA/PTW?

  Yes

  No

  N/A

• Was the work area correctly set up according to DTRA/PTW?

  Yes

  No

  N/A

• Are the tools and equipement used compliant and suitable for the planned activities according to DTRA/PTW?

  Yes

  No

  N/A

• Was the toolbox meeting properly conducted before starting the activities according to DTRA/PTW?

  Yes

  No

  N/A

FURTHER CHECKS (if necessary)

• Do the activities require a PTW?

  Yes

  No

  N/A

• Do the activities follow the PTW exactly?

  Yes

  No

  N/A

• Do the activities require a Lifting Plan?

  Yes

  No

  N/A

• Do the activities follow the Lifting Plan exactly?

  Yes

  No

  N/A

• Were changes necessary with respect to the DTRA/PTW?

  Yes

  No

  N/A

• NOTE:

HIGHLIGHTED DURING INSPECTION

• NOTES

• MEDIA

  Media

LOWLIGHTED DURING INSPECTION

• NOTES

• MEDIA

  Media

CONCLUSIONS

• HSE Dept.

  Sign